Turkish archives of pediatrics最新文献

{"title":"The Etiology of Pediatric Hypertransaminasemia Before, During, and After the COVID-19 Pandemic: A Single-Center Experience from Türkiye.","authors":"Abdulkerim Elmas, Füsun Zeynep Akçam, Mustafa Akcam","doi":"10.65717/TurkArchPediatr.2026.26033","DOIUrl":"https://doi.org/10.65717/TurkArchPediatr.2026.26033","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate changes in the etiological distribution of pediatric hypertransaminasemia before, during, and after the COVID-19 pandemic and to assess their association with clinical presentation and biochemical severity.</p><p><strong>Methods: </strong>This retrospective study evaluated temporal changes in the etiology of pediatric hypertransaminasemia before, during, and after the COVID-19 pandemic. A total of 607 children (aged 3 months to 18 years) with alanine aminotransferase (ALT) >45 IU/L and/or aspartate aminotransferase (AST) >50 IU/L persisting for ≥2 months were analyzed across 3 defined periods. Demographic data, clinical findings, and etiological diagnoses were compared.</p><p><strong>Results: </strong>The most common causes of hypertransaminasemia were idiopathic (22.2%), abdominal trauma (17.4%), and other viral infections (14.2%). The distribution of etiologies showed variation across the 3 periods, with abdominal trauma predominating during the pandemic and autoimmune hepatitis emerging as the leading cause of severe hypertransaminasemia (ALT>1000 IU/L) post-pandemic. Asymptomatic cases and incidental enzyme elevations increased over time.</p><p><strong>Conclusion: </strong>The observed temporal shifts were primarily associated with indirect pandemic-related behavioral changes and healthcare utilization patterns rather than direct COVID-19-related liver involvement. These findings highlight how pandemic-related behavioral changes and population-level vaccination context may have influenced the diagnostic landscape of pediatric liver injury.</p>","PeriodicalId":75267,"journal":{"name":"Turkish archives of pediatrics","volume":"61 9","pages":"830-837"},"PeriodicalIF":2.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148932151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Clinical and Laboratory Findings Between Skin-limited and Cutaneous-Articular Immunoglobulin A Vasculitis in Children.","authors":"Halil Kazanasmaz, Fırat Gündoğmuş, Ender Can Eroğlu, Mukaddes Kalyoncu","doi":"10.65717/TurkArchPediatr.2026.26025","DOIUrl":"https://doi.org/10.65717/TurkArchPediatr.2026.26025","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the clinical and laboratory characteristics of skin-limited and cutaneous-articular immunoglobulin A vasculitis (IgAV) in children without gastrointestinal or renal involvement, and to assess whether C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and antinuclear antibodies (ANAs) help differentiate these phenotypes.</p><p><strong>Methods: </strong>In this single-center retrospective study, children diagnosed with IgAV were identified from electronic medical records. Patients were classified as having skin-limited or cutaneous-articular IgAV according to standardized clinical criteria. Demographic features, rash patterns, acute-phase reactants, including CRP and ESR, complete blood count parameters, complement levels, and ANA were compared between the 2 phenotypes.</p><p><strong>Results: </strong>A total of 256 children were included (102 skin-limited, 154 cutaneous-articular). Demographic characteristics, rash distribution, hospitalization rates, and relapse frequency were similar between the phenotypes. C-reactive protein and ESR levels were significantly higher in the cutaneous-articular phenotype (P < .001), whereas hematological indices and complement levels did not differ significantly between groups. The ANA positivity was approximately 3-fold more frequent in children with articular involvement (27.3% vs. 8.8%, P < .001); however, the frequency of rheumatologic disease development during follow-up was similar between phenotypes (P=.42). Receiver-operating characteristic analyses demonstrated modest discrimination with low specificities for CRP and ESR.</p><p><strong>Conclusion: </strong>Children with cutaneous-articular IgAV show a higher inflammatory profile than those with skin-limited disease. However, routine laboratory markers have limited utility for phenotypic discrimination. Despite higher ANA positivity in the cutaneous-articular phenotype, similar rates of additional rheumatologic diagnoses during follow-up suggest that this finding should be interpreted cautiously.</p>","PeriodicalId":75267,"journal":{"name":"Turkish archives of pediatrics","volume":"61 9","pages":"785-792"},"PeriodicalIF":2.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148932157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Etiological Evaluation of Male Patients with Central Precocious Puberty: Findings from a Single-Center Cohort.","authors":"Tuğba Kontbay Çetin, Emel Gül Açıkgöz","doi":"10.65717/TurkArchPediatr.2026.25562","DOIUrl":"https://doi.org/10.65717/TurkArchPediatr.2026.25562","url":null,"abstract":"<p><strong>Objective: </strong>Central precocious puberty (CPP) is considerably less common in boys than in girls, and its underlying causes are more heterogeneous. Although earlier reports emphasized a high frequency of central nervous system (CNS) lesions in affected boys, recent data suggest a rising proportion of idiopathic cases.</p><p><strong>Methods: </strong>In this retrospective cross-sectional study, medical records of 46 boys diagnosed with CPP between 2015 and 2025 were reviewed. Clinical data included age at diagnosis, anthropometry, pubertal stage, bone age (BA), hormonal measurements, and brain magnetic resonance imaging (MRI) findings. Patients were categorized as idiopathic or neurogenic CPP according to MRI results. Group comparisons were performed using appropriate statistical tests, with P < .05 considered significant.</p><p><strong>Results: </strong>The mean age at diagnosis was 8.17 ± 1.73 years, and nearly half of the patients were referred for non-pubertal concerns. Magnetic resonance imaging (MRI) was normal in 68% of cases, while 32% had neurogenic CPP. The most frequent lesions were hypoxic-ischemic encephalopathy sequelae (20%), partial empty sella (20%), hypothalamic hamartoma (13%), and Rathke's cleft cysts (13%). No significant differences were found between idiopathic and neurogenic groups regarding basal luteinising hormone (LH), peak LH, testosterone levels, BA advancement, or pubertal stage at presentation.</p><p><strong>Conclusion: </strong>In this cohort, idiopathic CPP constituted the majority of cases in boys, supporting recent epidemiological trends. Clinical and hormonal parameters did not reliably distinguish neurogenic from idiopathic CPP, underscoring the continued importance of cranial MRI in evaluating boys with CPP. Larger, multi center studies with long-term follow-up are needed to refine risk stratification and imaging indications in this population.</p>","PeriodicalId":75267,"journal":{"name":"Turkish archives of pediatrics","volume":"61 8","pages":"683-689"},"PeriodicalIF":2.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Body Fat Mass Influence the Timing of Puberty in Boys with Constitutional Delay of Growth and Puberty?","authors":"Gözde Akın Kağızmanlı, Korcan Demir, Ece Böber, Ayhan Abacı","doi":"10.65717/TurkArchPediatr.2026.25450","DOIUrl":"https://doi.org/10.65717/TurkArchPediatr.2026.25450","url":null,"abstract":"<p><strong>Objective: </strong>In girls, a strong relationship exists between body fat percentage (BFP) and pubertal development, with a critical fat threshold considered essential for the initiation of puberty. In contrast, research addressing the impact of body composition on the timing of puberty in boys remains limited, and the available findings are inconsistent. To evaluate the association between body composition and delayed pubertal development in boys with constitutional delay of growth and puberty (CDGP) compared with healthy peers.</p><p><strong>Methods: </strong>Thirty-one boys with CDGP and 31 age-matched healthy males (Tanner stage 2-4) were included. Body composition was assessed using bioelectrical impedance analysis. Body fat percentage (BFP), fat mass (FM), fat-free mass (FFM), fat mass index (FMI), and fat-free mass index (FFMI) were evaluated. A BFP value of 17% was used as a descriptive reference rather than a validated biological cut-off.</p><p><strong>Results: </strong>The mean chronological age was 14.1 ± 0.5 years in the CDGP group and 13.9 ± 1.1 years in the control group (P = .4). Compared with controls, boys with CDGP had significantly lower body mass index (BMI) standard deviation (SD) scores (P = .01). FM and FM SD scores were also significantly lower (both P = .002), and BFP was reduced (P = .03). No significant difference in BFP SD score was observed between groups (P > .05). The FFM/FM ratio was higher in the CDGP group (P = .04). FMI, FMI SD score, FFMI, and FFMI SD score were all significantly lower in boys with CDGP (P = .02, P = .02, P = .009, and P = .009, respectively). A BFP below 17% was observed in 58.1% of CDGP patients compared with 9.7% of controls (P < .001).</p><p><strong>Conclusion: </strong>Lower BMI, FM, and FFMI were associated with delayed pubertal onset in boys with CDGP, suggesting a potential relationship between reduced adiposity, lean mass, and the timing of pubertal development.</p>","PeriodicalId":75267,"journal":{"name":"Turkish archives of pediatrics","volume":"61 9","pages":"815-821"},"PeriodicalIF":2.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148932153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Vitamin B12 Deficiency and Insufficiency in Children in Terms of Hemogram Parameters.","authors":"Hilal Koyuncu, Ayşe Tolunay Oflu, Aysun Soyugüzel, Ahsen Başaran, Ayşe Güngör, Ayşegül Bükülmez, İbrahim Eker","doi":"10.65717/TurkArchPediatr.2026.25464","DOIUrl":"https://doi.org/10.65717/TurkArchPediatr.2026.25464","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to investigate whether hemogram findings change in children with vitamin B12 deficiency or insufficiency.</p><p><strong>Methods: </strong>A total of 495 cases were included in the study. Of these, 158 patients (32.0%) with vitamin B12 levels below 200 pg/mL were classified as group 1, while 336 patients (68.0%) with levels between 200 and 300 pg/mL were classified as group 2. The hemogram parameters of the cases were compared.</p><p><strong>Results: </strong>This cross-sectional study examined the electronic records of patients who visited the pediatric outpatient clinic of a tertiary hospital between 2022 and 2024. Hematological findings were detected in 63 (12.8%) of all cases, including 25 (5%) of those with vitamin B12 deficiency. Anemia was detected in 28 patients (5.7%), and macrocytosis in 12 patients (2.4%), with no significant difference between the 2 groups (P = .408 and P=.212, respectively). Only 1 patient had macrocytic anemia. Leukopenia and bicytopenia were significantly more prevalent among patients with vitamin B12 deficiency (P=.015 and P=.014, respectively).</p><p><strong>Conclusion: </strong>This study demonstrated that while hematological findings may be normal in vitamin B12 deficiency, anemia, macrocytosis, macrocytic anemia, and reductions in other cell lines may be observed in cases of insufficiency. It also determined that the presence of macrocytosis is not a prerequisite for diagnosing vitamin B12 deficiency.</p>","PeriodicalId":75267,"journal":{"name":"Turkish archives of pediatrics","volume":"61 7","pages":"581-586"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Academic Mobbing: A Silent Threat to Institutional Integrity.","authors":"Ekim Z Taşkıran","doi":"10.65717/TurkArchPediatr.2026.7001","DOIUrl":"10.65717/TurkArchPediatr.2026.7001","url":null,"abstract":"","PeriodicalId":75267,"journal":{"name":"Turkish archives of pediatrics","volume":"61 7","pages":"565-566"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preserved Linear Growth in Children with Difficult-to-Treat Nephrotic Syndrome: A 25-Year Longitudinal Cohort Study.","authors":"Esra Karabag Yilmaz, Arlin Tunc, Ayse Agbas, Seha Saygılı, Salim Calıskan, Lale Sever, Nur Canpolat","doi":"10.65717/TurkArchPediatr.2026.26007","DOIUrl":"https://doi.org/10.65717/TurkArchPediatr.2026.26007","url":null,"abstract":"<p><strong>Objective: </strong>Difficult-to-treat nephrotic syndrome (NS), including frequently relapsing nephrotic syndrome (FRNS), steroid-dependent nephrotic syndrome (SDNS), and steroid-resistant nephrotic syndrome (SRNS) forms, often requires prolonged corticosteroid therapy and may adversely affect linear growth. Although steroid-sparing agents are increasingly used, longterm growth outcomes in this population remain insufficiently defined. This study aimed to evaluate long-term growth patterns and the impact of cumulative steroid exposure and steroid-sparing therapies in children with difficult-to-treat NS.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 57 children with difficult-to-treat NS (38 SDNS/FRNS, 19 SRNS) followed between 2000 and 2025. Height standard deviation scores (SDS) at baseline, last follow-up, and estimated target height were assessed, and a decline of >1 SDS was evaluated as a clinically relevant outcome. Cumulative steroid dose, time-weighted steroid exposure using area under the curve (AUC), average daily steroid exposure, and the use of steroid-sparing therapies were recorded.</p><p><strong>Results: </strong>The median follow-up duration was 7.5 years, and median age at last visit was 15 years. Median cumulative steroid exposure was 431 mg/kg, with a steroid AUC of 511 mg/kg*year and an average daily steroid exposure of 0.18 mg/kg/day. Short stature was observed in one patient (2%). Height SDS at the final evaluation did not differ from baseline or target height, and similar findings were observed in SDNS/FRNS and SRNS subgroups. Overall, 46 patients (81%) had stable or improved height SDS, while 11 patients (19%) showed a decline of >1 SDS. No clinical, histopathological, or treatment-related factors were associated with height SDS decline.</p><p><strong>Conclusions: </strong>Long-term linear growth was largely preserved in children with difficult-to-treat NS, and short stature was uncommon. Favorable growth outcomes appear achievable with contemporary management strategies incorporating effective disease control and steroid-sparing therapy.</p>","PeriodicalId":75267,"journal":{"name":"Turkish archives of pediatrics","volume":"61 7","pages":"633-640"},"PeriodicalIF":2.3,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Intralesional and Systemic Bevacizumab in Refractory Juvenile-Onset Recurrent Respiratory Papillomatosis in a Preterm Patient: Clinical Perspectives.","authors":"Kribananthan Lohanadan, Azliana Aziz, Hazama Mohamad, Suzina Sheikh Ab Hamid","doi":"10.65717/TurkArchPediatr.2026.25534","DOIUrl":"https://doi.org/10.65717/TurkArchPediatr.2026.25534","url":null,"abstract":"","PeriodicalId":75267,"journal":{"name":"Turkish archives of pediatrics","volume":"61 10","pages":"954-956"},"PeriodicalIF":2.3,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pleuroparenchymal Fibroelastosis in Children: A Rare Interstitial Lung Disease with Distinct Features.","authors":"Dilara Demirel, Deniz Doğru, Diclehan Orhan, H Nursun Özcan, Nagehan Emiralioğlu Ordukaya, Ebru Yalçın, Uğur Özçelik","doi":"10.65717/TurkArchPediatr.2026.25544","DOIUrl":"https://doi.org/10.65717/TurkArchPediatr.2026.25544","url":null,"abstract":"","PeriodicalId":75267,"journal":{"name":"Turkish archives of pediatrics","volume":"61 10","pages":"952-953"},"PeriodicalIF":2.3,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary Assessment of Patients Co-managed by Pediatric Rheumatology and the Pediatric Intensive Care Unit.","authors":"Neslihan Kara Çanlıoğlu, Hazal Ceren Tuğrul, Eray Tunce, Sıla Atamyıldız Uçar, Gürkan Atay, Seher Erdoğan, Betül Sözeri","doi":"10.65717/TurkArchPediatr.2026.25489","DOIUrl":"https://doi.org/10.65717/TurkArchPediatr.2026.25489","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to describe the diagnostic spectrum, management strategies, and outcomes of critically ill children co-managed by rheumatology and the pediatric intensive care unit (PICU).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at a tertiary referral hospital PICU with integrated pediatric rheumatology collaboration between August 2016 and January 2025. Patients were categorized into 2 groups: Group 1 comprised children with a previously established rheumatologic diagnosis prior to PICU admission (n=20), and Group 2 comprised children without a known rheumatologic diagnosis at PICU admission who were either newly diagnosed during the PICU stay or required pediatric rheumatology involvement for hyperin-flammatory conditions (n=67). Patients who neither received a rheumatologic diagnosis norrequired pediatric rheumatology involvement during PICU admission were excluded. Data on demographic characteristics, diagnoses, treatments, and mortality were analyzed.</p><p><strong>Results: </strong>In Group 1, vasculitis (35%), systemic lupus erythematosus (SLE, 25%), and systemic juvenile idiopathic arthritis (30%) predominated; most were admitted with disease flare. Mortality was highest in SLE (60% in Group 1, 43% overall). In Group 2, secondary hemophagocytic lymphohistiocytosis (HLH) was the most common diagnosis (n=56). Mortality reached 28.3% in secondary HLH. Non-survivors more frequently required mechanical ventilation within the first 24 hours of PICU admission. Median PICU stay ranged from 5 days in vasculitis to 13 days in SLE.</p><p><strong>Conclusion: </strong>Critically ill children co-managed by rheumatology and intensive care teams most often present with hyperinflammatory syndromes. Early rheumatology involvement and multidisciplinary care appear essential for optimal patient outcomes.</p>","PeriodicalId":75267,"journal":{"name":"Turkish archives of pediatrics","volume":"61 7","pages":"624-632"},"PeriodicalIF":2.3,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}